Occipital Headaches and Neuroimaging in Children

The International Classification of Headache Disorders (ICHD-3 beta) suggests that headaches localizing to the occipital region in children may be indicative of an intracranial process. This sentiment, however, is not noted in the American Academy of Neurology (AAN) and Child Neurology Society (CNS) practice parameters. To determine if there is merit to the assumed association, researchers conducted a retrospective chart review study of patients presenting to a child neurology clinic in 2009.

Of nearly 600 patients screened, 308 were included in the study. Forty-two children reported pain in the occipital area, 21 exclusively. Overall, two thirds (205 of 308) received neuroimaging but almost 90% of those with occipital pain received imaging (37 of 42). Of all those imaged, only four had a concerning finding (2 tumors, 1 of which was considered incidental, and two with signs of increased intracranial pressure). None of the four reported occipital pain. The authors conclude that occipital pain in the absence of abnormal history or clinical findings is neither uncommon nor concerning for intracranial pathology yet leads to more imaging than other pediatric headaches.